Staged approaches for large skull base chordomas and chondrosarcomas

Paulo A.S. Kadri, Francisco Vaz-Guimaraes, Griffith R. Harsh, Rami O. Al-Mefty, Ossama Al-Mefty

Research output: Chapter in Book/Report/Conference proceedingChapter

Abstract

Chordomas and chondrosarcomas are different histopathological entities with markedly different natural history and clinical outcomes. Sharing a similar clinical and radiological presentation, their definite identification is confirmed only by immunohistological stain (cytokeratin, EMA, and brachyury). One common prognostic feature is the radicality achieved with surgical resection. Due to their large or giant size at presentation or their extension to multiple anatomical compartments, radical resection of these tumors often requires more than one approach or one surgical procedure, and staged surgery becomes necessary. The pursuit of gross total removal improves the disease-free survival in chordoma, knowing that a high-dose radiation therapy will be given in addition, whereas in chondrosarcoma, achieving total removal would eliminate the need for radiation. Multiple and staged surgery requires thorough planning that takes into consideration the recovery time, reconstruction, donor site of autologous tissue, and the potential complications of the approach, particularly of cerebrospinal fluid leak. As a rule, the surgical treatment of chordomas and chondrosarcomas should aim to achieve total and radical removal. This will require mastering and utilizing various skull base approaches and employing all the technical advancements available in our armamentarium and the availability of intraoperative imaging and navigation.

Original languageEnglish (US)
Title of host publicationChordomas and Chondrosarcomas of the Skull Base and Spine
PublisherElsevier Inc.
Pages231-240
Number of pages10
ISBN (Electronic)9780128043332
ISBN (Print)9780128042571
DOIs
StatePublished - 2018
Externally publishedYes

Keywords

  • Chondrosarcoma
  • Chordoma
  • Clivus
  • Skull base tumors
  • Surgical approaches
  • Tumor excision

ASJC Scopus subject areas

  • Medicine(all)
  • Neuroscience(all)

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